Abnormal functional corticomuscular coupling after stroke

Concurrent spinal and brain imaging with optically pumped magnetometers

BACKGROUND

The spinal cord and its interactions with the brain are fundamental for movement control and somatosensation. However, brain and spinal electrophysiology in humans have largely been treated as distinct enterprises, in part due to the relative inaccessibility of the spinal cord. Consequently, there is a dearth of knowledge on human spinal electrophysiology, including the multiple pathologies that affect the spinal cord as well as the brain.

NEW METHOD

Here we exploit recent advances in the development of wearable optically pumped magnetometers (OPMs) which can be flexibly arranged to provide coverage of both the spinal cord and the brain in relatively unconstrained environments. This system for magnetospinoencephalography (MSEG) measures both spinal and cortical signals simultaneously by employing custom-made scanning casts.

RESULTS

We evidence the utility of such a system by recording spinal and cortical evoked responses to median nerve stimulation at the wrist. MSEG revealed early (10 - 15 ms) and late (>20 ms) responses at the spinal cord, in addition to typical cortical evoked responses (i.e., N20).

COMPARISON WITH EXISTING METHODS

Early spinal evoked responses detected were in line with conventional somatosensory evoked potential recordings.

CONCLUSION

This MSEG system demonstrates the novel ability for concurrent non-invasive millisecond imaging of brain and spinal cord.

Improvements in motor control are associated with improved quality of life following an at-home muscle biofeedback program for chronic stroke

Introduction

Chronic stroke survivors with severe arm impairment have limited options for effective rehabilitation. High intensity, repetitive task practice (RTP) is known to improve upper limb function among stroke survivors who have some volitional muscle activation. However, clients without volitional movement of their arm are ineligible for RTP-based interventions and require hands-on facilitation from a clinician or robotic therapy to simulate task practice. Such approaches can be expensive, burdensome, and have marginal effects. Alternatively, supervised at-home telerehabilitation using muscle biofeedback may provide a more accessible, affordable, and effective rehabilitation option for stroke survivors with severe arm impairment, and could potentially help people with severe stroke regain enough volitional activation to be eligible for RTP-types of therapies. Feedback of muscle activity via electromyography (EMG) has been previously used with clients who have minimal or no movement to improve functional performance. Specifically, training to reduce unintended co-contractions of the impaired hand using EMG biofeedback may modestly improve motor control in people with limited movement. Importantly, these modest and covert functional changes may influence the perceived impact of stroke-related disability in daily life. In this manuscript, we examine whether physical changes following use of a portable EMG biofeedback system (Tele-REINVENT) for severe upper limb hemiparesis also relate to perceived quality of life improvements. Secondarily, we examined the effects of Tele-REINVENT, which uses EMG to quantify antagonistic muscle activity during movement attempt trials and transform individuated action into computer game control, on several different domains of stroke recovery.

Methods

For this pilot study, nine stroke survivors (age = 37-73 years) with chronic impairment (Fugl-Meyer = 14-40/66) completed 30 1-hour sessions of home-based training, consisting of six weeks of gaming that reinforced wrist extensor muscle activity while attenuating coactivation of flexor muscles. To assess motor control and performance, we measured changes in active wrist ranges of motion, the Fugl-Meyer Assessment, and Action Research Arm Test. We also collected an EMG-based test of muscle control to examine more subtle changes. To examine changes in perceived quality of life, we utilized the Stroke Impact Scale along with participant feedback.

Results

Results from our pilot data suggest that 30 sessions of remote training can induce modest changes on clinical and functional assessments, showing a statistically significant improvement of active wrist ranges of motion at the group level, changes that could allow some people with severe stroke to be eligible for other therapeutic approaches, such as RTP. Additionally, changes in motor control were correlated with the perceived impact of stroke on participation and impairment after training. We also report changes in corticomuscular coherence, which showed a laterality change from the ipsilesional motor cortex towards the contralesional hemisphere during wrist extension attempts. Finally, all participants showed high adherence to the protocol and reported enjoying using the system.

Conclusion

Overall, Tele-REINVENT represents a promising telerehabilitation intervention that might improve sensorimotor outcomes in severe chronic stroke, and that improving sensorimotor abilities even modestly may improve quality of life. We propose that Tele-REINVENT may be used as a precursor to help participants gain enough active movement to participate other occupational therapy interventions, such as RTP. Future work is needed to examine if home-based telerehabilitation to provide feedback of individuated muscle activity could increase meaningful rehabilitation accessibility and outcomes for underserved populations.

Influencing factors of corticomuscular coherence in stroke patients

Stroke, also known as cerebrovascular accident, is an acute cerebrovascular disease with a high incidence, disability rate, and mortality. It can disrupt the interaction between the cerebral cortex and external muscles. Corticomuscular coherence (CMC) is a common and useful method for studying how the cerebral cortex controls muscle activity. CMC can expose functional connections between the cortex and muscle, reflecting the information flow in the motor system. Afferent feedback related to CMC can reveal these functional connections. This paper aims to investigate the factors influencing CMC in stroke patients and provide a comprehensive summary and analysis of the current research in this area. This paper begins by discussing the impact of stroke and the significance of CMC in stroke patients. It then proceeds to elaborate on the mechanism of CMC and its defining formula. Next, the impacts of various factors on CMC in stroke patients were discussed individually. Lastly, this paper addresses current challenges and future prospects for CMC.

Neurobiomechanical mechanism of Tai Chi to improve upper limb coordination function in post-stroke patients: a study protocol for a randomized controlled trial

BACKGROUND

Upper limb dysfunction seriously affects the ability of stroke patients to perform activities of daily living. As a popular exercise therapy, Tai Chi may become an alternative intervention. However, the neurophysiological mechanism by which Tai Chi improves upper limb dysfunction in stroke patients is still unclear, which limits its further promotion and application. Therefore, conducting a strict randomized clinical trial is necessary to observe how Tai Chi affects upper limb dysfunction in stroke patients and to explore its neurophysiological mechanism.

METHODS/DESIGN

This report describes a randomized, parallel-controlled trial with distributive concealment and evaluator blinding. A total of 84 eligible participants will be randomly assigned to the Tai Chi group or the control group in a 1:1 ratio. The participants in the Tai Chi group will receive 4 weeks of Tai Chi training: five 60-min sessions a week for a total of 20 sessions. The participants in the control group will not receive Tai Chi training. Both groups will receive medical treatment and routine rehabilitation training. The primary outcome measure is the mean change in the Fugl-Meyer Assessment Upper Extremity (FMA-UE) scale score between baseline and 4 weeks; the secondary outcomes are the mean changes in kinematic characteristics and the Wolf Motor Function Test (WMFT) and Stroke Impact Scale (SIS) scores. In addition, the corticomuscular coupling level and near-infrared brain functional imaging will be monitored to explore the mechanism by which Tai Chi improves upper limb function of stroke patients.

DISCUSSION

This randomized controlled trial will examine the effectiveness of Tai Chi in stroke patients with upper limb dysfunction and explore the neurophysiological mechanism. Positive results will verify that Tai Chi can improve upper limb function of stroke patients.

TRIAL REGISTRATION

Chinese Clinical Trial Registration Center, ChiCTR2200061376 (retrospectively registered). Registered June 22, 2022. http://www.chictr.org.cn/listbycreater.aspx . Manuscript Version: 3.0 Manuscript Date: October 10, 2023.

Evaluation of movement functional rehabilitation after stroke: A study via graph theory and corticomuscular coupling as potential biomarker

Changes in the functional connections between the cerebral cortex and muscles can evaluate motor function in stroke rehabilitation. To quantify changes in functional connections between the cerebral cortex and muscles, we combined corticomuscular coupling and graph theory to propose dynamic time warped (DTW) distances for electroencephalogram (EEG) and electromyography (EMG) signals as well as two new symmetry metrics. EEG and EMG data from 18 stroke patients and 16 healthy individuals, as well as Brunnstrom scores from stroke patients, were recorded in this paper. First, calculate DTW-EEG, DTW-EMG, BNDSI and CMCSI. Then, the random forest algorithm was used to calculate the feature importance of these biological indicators. Finally, based on the results of feature importance, different features were combined and validated for classification. The results showed that the feature importance was from high to low as CMCSI/BNDSI/DTW-EEG/DTW-EMG, while the feature combination with the highest accuracy was CMCSI+BNDSI+DTW-EEG. Compared to previous studies, combining the CMCSI+BNDSI+DTW-EEG features of EEG and EMG achieved better results in the prediction of motor function rehabilitation at different levels of stroke. Our work implies that the establishment of a symmetry index based on graph theory and cortical muscle coupling has great potential in predicting stroke recovery and promises to have an impact on clinical research applications.

Gamma frequency entrainment rescues cognitive impairment by decreasing postsynaptic transmission after traumatic brain injury

INTRODUCTION

The relationship between oscillatory activity in hippocampus and cognitive impairment in traumatic brain injury (TBI) remains unclear. Although TBI decreases gamma oscillations and 40 Hz light flicker improves TBI prognosis, the effects and mechanism of rhythmic flicker on TBI remain unclear.

AIMS

In this study, we aimed to explore whether light flicker could reverse cognitive deficits, and further explore its potential mechanisms in TBI mouse model.

METHODS

The Morris water maze test (MWM), step-down test (SDT), and novel object recognition test (NOR) were applied to evaluate the cognitive ability. The local field potential (LFP) recording was applied to measure low gamma reduction of CA1 in hippocampus after TBI. And electrophysiological experiments were applied to explore effects of the gamma frequency entrainment on long-term potentiation (LTP), postsynaptic transmission, and intrinsic excitability of CA1 pyramidal cells (PCs) in TBI mice. Immunofluorescence staining and western blotting were applied to explore the effects of 40 Hz light flicker on the expression of PSD95 in hippocampus of TBI mice.

RESULTS

We found that 40 Hz light flicker restored low gamma reduction of CA1 in hippocampus after TBI. And 40 Hz, but not random or 80 Hz light flicker, reversed cognitive impairment after TBI in behavioral tests. Moreover, 40 Hz light flicker improved N-methyl-D-aspartate (NMDA) receptor-dependent LTP (LTP_NMDAR ) and L-type voltage-gated calcium channel-dependent LTP (LTP_L-VGCC ) after TBI treatment. And gamma frequency entrainment decreased excitatory postsynaptic currents (EPSCs) of CA1 PCs in TBI mice. Our results have illustrated that 40 Hz light flicker could decrease intrinsic excitability of PCs after TBI treatment in mice. Furthermore, 40 Hz light flicker decreased the expression of PSD95 in hippocampus of TBI mice.

CONCLUSION

These results demonstrated that 40 Hz light flicker rescues cognitive impairment by decreasing postsynaptic transmission in PCs after TBI treatment in mice.

Tailoring brain-machine interface rehabilitation training based on neural reorganization: towards personalized treatment for stroke patients

Electroencephalogram (EEG)-based brain-machine interface (BMI) has the potential to enhance rehabilitation training efficiency, but it still remains elusive regarding how to design BMI training for heterogeneous stroke patients with varied neural reorganization. Here, we hypothesize that tailoring BMI training according to different patterns of neural reorganization can contribute to a personalized rehabilitation trajectory. Thirteen stroke patients were recruited in a 2-week personalized BMI training experiment. Clinical and behavioral measurements, as well as cortical and muscular activities, were assessed before and after training. Following treatment, significant improvements were found in motor function assessment. Three types of brain activation patterns were identified during BMI tasks, namely, bilateral widespread activation, ipsilesional focusing activation, and contralesional recruitment activation. Patients with either ipsilesional dominance or contralesional dominance can achieve recovery through personalized BMI training. Results indicate that personalized BMI training tends to connect the potentially reorganized brain areas with event-contingent proprioceptive feedback. It can also be inferred that personalization plays an important role in establishing the sensorimotor loop in BMI training. With further understanding of neural rehabilitation mechanisms, personalized treatment strategy is a promising way to improve the rehabilitation efficacy and promote the clinical use of rehabilitation robots and other neurotechnologies.

Literature review of stroke assessment for upper-extremity physical function via EEG, EMG, kinematic, and kinetic measurements and their reliability

BACKGROUND

Significant clinician training is required to mitigate the subjective nature and achieve useful reliability between measurement occasions and therapists. Previous research supports that robotic instruments can improve quantitative biomechanical assessments of the upper limb, offering reliable and more sensitive measures. Furthermore, combining kinematic and kinetic measurements with electrophysiological measurements offers new insights to unlock targeted impairment-specific therapy. This review presents common methods for analyzing biomechanical and neuromuscular data by describing their validity and reporting their reliability measures.

METHODS

This paper reviews literature (2000-2021) on sensor-based measures and metrics for upper-limb biomechanical and electrophysiological (neurological) assessment, which have been shown to correlate with clinical test outcomes for motor assessment. The search terms targeted robotic and passive devices developed for movement therapy. Journal and conference papers on stroke assessment metrics were selected using PRISMA guidelines. Intra-class correlation values of some of the metrics are recorded, along with model, type of agreement, and confidence intervals, when reported.

RESULTS

A total of 60 articles are identified. The sensor-based metrics assess various aspects of movement performance, such as smoothness, spasticity, efficiency, planning, efficacy, accuracy, coordination, range of motion, and strength. Additional metrics assess abnormal activation patterns of cortical activity and interconnections between brain regions and muscle groups; aiming to characterize differences between the population who had a stroke and the healthy population.

CONCLUSION

Range of motion, mean speed, mean distance, normal path length, spectral arc length, number of peaks, and task time metrics have all demonstrated good to excellent reliability, as well as provide a finer resolution compared to discrete clinical assessment tests. EEG power features for multiple frequency bands of interest, specifically the bands relating to slow and fast frequencies comparing affected and non-affected hemispheres, demonstrate good to excellent reliability for populations at various stages of stroke recovery. Further investigation is needed to evaluate the metrics missing reliability information. In the few studies combining biomechanical measures with neuroelectric signals, the multi-domain approaches demonstrated agreement with clinical assessments and provide further information during the relearning phase. Combining the reliable sensor-based metrics in the clinical assessment process will provide a more objective approach, relying less on therapist expertise. This paper suggests future work on analyzing the reliability of metrics to prevent biasedness and selecting the appropriate analysis.

Effects of auditory feedback on fine motor output and corticomuscular coherence during a unilateral finger pinch task

Auditory feedback is important to reduce movement error and improve motor performance during a precise motor task. Accurate motion guided by auditory feedback may rely on the neural muscle transmission pathway between the sensorimotor area and the effective muscle. However, it remains unclear how neural activities and sensorimotor loops play a role in enhancing performance. The present study uses an auditory feedback system by simultaneously recording electroencephalogram (EEG), electromyography (EMG), and exert force information to measure corticomuscular coherence (CMC), neural activity, and motor performance during precise unilateral right-hand pinch by using the thumb and the index finger with and without auditory feedback. This study confirms three results. First, compared with no auditory feedback, auditory feedback decreases movement errors. Second, compared with no auditory feedback, auditory feedback decreased the power spectrum in the beta band in the bimanual sensorimotor cortex and the alpha band in the ipsilateral sensorimotor cortex. Finally, CMC was computed between effector muscle of right hand and contralateral sensorimotor cortex. Analyses reveals that the CMC of beta band significantly decreases in auditory feedback condition compared with no auditory feedback condition. The results indicate that auditory feedback decreases the power spectral in the alpha and beta bands and decreases corticospinal connection in the beta band during precise hand control. This study provides a new perspective on the effect of auditory feedback on behavior and brain activity and offers a new idea for designing more suitable and effective rehabilitation and training strategies to improve fine motor performance.

Feature stability and setup minimization for EEG-EMG-enabled monitoring systems

Delivering health care at home emerged as a key advancement to reduce healthcare costs and infection risks, as during the SARS-Cov2 pandemic. In particular, in motor training applications, wearable and portable devices can be employed for movement recognition and monitoring of the associated brain signals. This is one of the contexts where it is essential to minimize the monitoring setup and the amount of data to collect, process, and share. In this paper, we address this challenge for a monitoring system that includes high-dimensional EEG and EMG data for the classification of a specific type of hand movement. We fuse EEG and EMG into the magnitude squared coherence (MSC) signal, from which we extracted features using different algorithms (one from the authors) to solve binary classification problems. Finally, we propose a mapping-and-aggregation strategy to increase the interpretability of the machine learning results. The proposed approach provides very low mis-classification errors ( < 0.1 ), with very few and stable MSC features ( < 10 % of the initial set of available features). Furthermore, we identified a common pattern across algorithms and classification problems, i.e., the activation of the centro-parietal brain areas and arm's muscles in 8-80 Hz frequency band, in line with previous literature. Thus, this study represents a step forward to the minimization of a reliable EEG-EMG setup to enable gesture recognition.

Relation Between EEG Measures and Upper Limb Motor Recovery in Stroke Patients: A Scoping Review

Current clinical practice does not leverage electroencephalography (EEG) measurements in stroke patients, despite its potential to contribute to post-stroke recovery predictions. We review the literature on the effectiveness of various quantitative and qualitative EEG-based measures after stroke as a tool to predict upper limb motor outcome, in relation to stroke timeframe and applied experimental tasks. Moreover, we aim to provide guidance on the use of EEG in the assessment of upper limb motor recovery after stroke, suggesting a high potential for some metrics in the appropriate context. We identified relevant papers (N = 16) from databases ScienceDirect, Web of Science and MEDLINE, and assessed their methodological quality with the Joanna Briggs Institute (JBI) Critical Appraisal. We applied the Preferred Reporting Systems for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) Framework. Identified works used EEG to identify properties including event-related activation, spectral power in physiologically relevant bands, symmetry in brain dynamics, functional connectivity, cortico-muscular coherence and rhythmic coordination. EEG was acquired in resting state or in relation to behavioural conditions. Motor outcome was mainly evaluated with the Upper Limb Fugl-Meyer Assessment. Despite great variability in the literature, data suggests that the most promising EEG quantifiers for predicting post-stroke motor outcome are event-related measures. Measures of spectral power in physiologically relevant bands and measures of brain symmetry also show promise. We suggest that EEG measures may improve our understanding of stroke brain dynamics during recovery, and contribute to establishing a functional prognosis and choosing the rehabilitation approach.

Intermuscular coupling network analysis of upper limbs based on R-vine copula transfer entropy

In the field of neuroscience, it is very important to evaluate the causal coupling characteristics between bioelectrical signals accurately and effectively. Transfer entropy is commonly used to analyze complex data, especially the causal relationship between data with non-linear, multidimensional characteristics. However, traditional transfer entropy needs to estimate the probability density function of the variable, which is computationally complex and unstable. In this paper, a new and effective method for entropy transfer is proposed, by means of applying R-vine copula function estimation. The effectiveness of R-vine copula transfer entropy is first verified on several simulations, and then applied to intermuscular coupling analysis to explore the characteristics of the intermuscular coupling network of muscles in non-fatigue and fatigue conditions. The experiment results show that as the muscle group enters the fatigue state, the community structure can be adjusted and the muscle nodes participating in the exercise are fully activated, enabling the two-way interaction between different communities. Finally, it comes to the conclusion that the proposed method can make accurate inferences about complex causal coupling. Moreover, the characteristics of the intermuscular coupling network in both non-fatigue and fatigue states can provide a new theoretical perspective for the diagnosis of neuromuscular fatigue and sports rehabilitation, which has good application value.

Electroencephalographic Measurement on Post-stroke Sensory Deficiency in Response to Non-painful Cold Stimulation

Background

Reduced elementary somatosensation is common after stroke. However, the measurement of elementary sensation is frequently overlooked in traditional clinical assessments, and has not been evaluated objectively at the cortical level. This study designed a new configuration for the measurement of post-stroke elementary thermal sensation by non-painful cold stimulation (NPCS). The post-stroke cortical responses were then investigated during elementary NPCS on sensory deficiency via electroencephalography (EEG) when compared with unimpaired persons.

Method

Twelve individuals with chronic stroke and fifteen unimpaired controls were recruited. A 64-channel EEG system was used to investigate the post-stroke cortical responses objectively during the NPCS. A subjective questionnaire of cold sensory intensity was also administered via a numeric visual analog scale (VAS). Three water samples with different temperatures (i.e., 25, 10, and 0°C) were applied to the skin surface of the ventral forearm for 3 s via glass beaker, with a randomized sequence on either the left or right forearm of a participant. EEG relative spectral power (RSP) and topography were used to evaluate the neural responses toward NPCS with respect to the independent factors of stimulation side and temperature.

Results

For unimpaired controls, NPCS initiated significant RSP variations, mainly located in the theta band with the highest discriminative resolution on the different temperatures (P < 0.001). For stroke participants, the distribution of significant RSP spread across all EEG frequency bands and the temperature discrimination was lower than that observed in unimpaired participants (P < 0.05). EEG topography showed that the NPCS could activate extensive and bilateral sensory cortical areas after stroke. Significant group differences on RSP intensities were obtained in each EEG band (P < 0.05). Meanwhile, significant asymmetry cortical responses in RSP toward different upper limbs were observed during the NPCS in both unimpaired controls and participants with stroke (P < 0.05). No difference was found between the groups in the VAS ratings of the different temperatures (P > 0.05).

Conclusion

The post-stroke cortical responses during NPCS on sensory deficiency were characterized by the wide distribution of representative RSP bands, lowered resolution toward different temperatures, and extensive activated sensory cortical areas.

Enhancement of functional corticomuscular coupling after transcranial ultrasound stimulation in mice

OBJECTIVE

Transcranial ultrasound stimulation (TUS), a large penetration depth and high spatial resolution technology, has developed rapidly in recent years. This study aimed to explore and evaluate the neuromodulation effects of TUS on mouse motor neural circuits under different parameters.

APPROACH

Our study used functional corticomuscular coupling (FCMC) as an index to explore the modulation mechanism for movement control under different TUS parameters (intensity [Isppa] and stimulation duration [SD]). We collected local field potential (LFP) and tail electromyographic (EMG) data under TUS in healthy mice and then introduced the time-frequency coherence method to analyze the FCMC before and after TUS in the time-frequency domain. After that, we defined the relative coherence area (RCA) to quantify the coherence between LFP and EMG under TUS.

MAIN RESULTS

The FCMC at theta, alpha, beta, and gamma bands was enhanced after TUS, and the neuromodulation efficacy mainly occurred in the lower frequency band (theta and alpha band). After TUS with different parameters, the FCMC in all selected frequency bands showed a tendency of increasing first and then decreasing. Further analysis showed that the maximum coupling value of theta band appeared from 0.2 to 0.4 s, and that the maximum coupling value in alpha and gamma band appeared from 0 to 0.2 s.

SIGNIFICANCE

The aforementioned results demonstrate that FCMC in the motor cortex could be modulated by TUS. We provide a theoretical basis for further exploring the modulation mechanism of TUS parameters and clinical application.

Disrupted cortico-peripheral interactions in motor disorders

Motor disorders may arise from neurological damage or diseases at different levels of the hierarchical motor control system and side-loops. Altered cortico-peripheral interactions might be essential characteristics indicating motor dysfunctions. By integrating cortical and peripheral responses, top-down and bottom-up cortico-peripheral coupling measures could provide new insights into the motor control and recovery process. This review first discusses the neural bases of cortico-peripheral interactions, and corticomuscular coupling and corticokinematic coupling measures are addressed. Subsequently, methodological efforts are summarized to enhance the modeling reliability of neural coupling measures, both linear and nonlinear approaches are introduced. The latest progress, limitations, and future directions are discussed. Finally, we emphasize clinical applications of cortico-peripheral interactions in different motor disorders, including stroke, neurodegenerative diseases, tremor, and other motor-related disorders. The modified interaction patterns and potential changes following rehabilitation interventions are illustrated. Altered coupling strength, modified coupling directionality, and reorganized cortico-peripheral activation patterns are pivotal attributes after motor dysfunction. More robust coupling estimation methodologies and combination with other neurophysiological modalities might more efficiently shed light on motor control and recovery mechanisms. Future studies with large sample sizes might be necessary to determine the reliabilities of cortico-peripheral interaction measures in clinical practice.

A novel delay estimation method for improving corticomuscular coherence in continuous synchronization events

OBJECTIVE

While the corticomuscular coupling between motor cortex and muscle tissue has received considerable attention, which is typically quantitative measure to evaluate neural signals synchronization in the motor control system, little work has been published regarding the effect of underlying delay of two coupled physiological signals on coherence.

METHODS

In this study, we developed a novel delay estimation method, named rate of voxels change (RVC), detecting time delay in two coupled physiological signals. Based on RVC framework, delay compensation was used to adjust magnitude squared coherence (MSC) image. To illustrate the effectiveness of the RVC method, we compared the estimated delays and the adjusted MSC results based on RVC method and corticomuscular coherence with time lag (CMCTL) method.

RESULTS

The simulation results suggested that RVC method was not only superior to the CMCTL method in estimating different time delays, but also has better optimization effect on MSC image. The experimental results further confirmed that delay estimated by the proposed RVC method was more in line with the underlying physiology (controls: 22.8 ms vs patients: 34.5 ms). Meanwhile, RVC-based delay compensation could significantly optimize the MSC of specific regions.

SIGNIFICANCE

This study proved that RVC has remarkably higher reliability in detecting time delay between coupled neurophysiological signals, and the application of RVC was an improvement on the previous studies that mainly focused on biased MSC estimation.

Delta Sleep-Inducing Peptide Recovers Motor Function in SD Rats after Focal Stroke

Background and Objectives: Mutual effect of the preliminary and therapeutic intranasal treatment of SD rats with DSIP (8 days) on the outcome of focal stroke, induced with intraluminal middle cerebral occlusion (MCAO), was investigated. Materials and Methods: The groups were the following: MCAO + vehicle, MCAO + DSIP, and SHAM-operated. DSIP or vehicle was applied nasally 60 (±15) minutes prior to the occlusion and for 7 days after reperfusion at dose 120 µg/kg. The battery of behavioral tests was performed on 1, 3, 7, 14, and 21 days after MCAO. Motor coordination and balance and bilateral asymmetry were tested. At the end of the study, animals were euthanized, and their brains were perfused, serial cryoslices were made, and infarction volume in them was calculated. Results: Although brain infarction in DSIP-treated animals was smaller than in vehicle-treated animals, the difference was not significant. However, motor performance in the rotarod test significantly recovered in DSIP-treated animals. Conclusions: Intranasal administration of DSIP in the course of 8 days leads to accelerated recovery of motor functions.

Temporal Dynamics of Corticomuscular Coherence Reflects Alteration of the Central Mechanisms of Neural Motor Control in Post-Stroke Patients

The neural control of muscular activity during a voluntary movement implies a continuous updating of a mix of afferent and efferent information. Corticomuscular coherence (CMC) is a powerful tool to explore the interactions between the motor cortex and the muscles involved in movement realization. The comparison of the temporal dynamics of CMC between healthy subjects and post-stroke patients could provide new insights into the question of how agonist and antagonist muscles are controlled related to motor performance during active voluntary movements. We recorded scalp electroencephalography activity, electromyography signals from agonist and antagonist muscles, and upper limb kinematics in eight healthy subjects and seventeen chronic post-stroke patients during twenty repeated voluntary elbow extensions and explored whether the modulation of the temporal dynamics of CMC could contribute to motor function impairment. Concomitantly with the alteration of elbow extension kinematics in post-stroke patients, dynamic CMC analysis showed a continuous CMC in both agonist and antagonist muscles during movement and highlighted that instantaneous CMC in antagonist muscles was higher for post-stroke patients compared to controls during the acceleration phase of elbow extension movement. In relation to motor control theories, our findings suggest that CMC could be involved in the online control of voluntary movement through the continuous integration of sensorimotor information. Moreover, specific alterations of CMC in antagonist muscles could reflect central command alterations of the selectivity in post-stroke patients.

Temporal control of muscle synergies is linked with alpha-band neural drive

KEY POINTS

It is theorized that the nervous system controls groups of muscles together as functional units, or 'synergies', resulting in correlated electromyographic (EMG) signals among muscles. However, such correlation does not necessarily imply group-level neural control. Oscillatory synchronization (coherence) among EMG signals implies neural coupling, but it is not clear how this relates to control of muscle synergies. EMG was recorded from seven arm muscles of 10 adult participants rotating an upper limb ergometer, and EMG-EMG coherence, EMG amplitude correlations and their relationship with each other were characterized. A novel method to derive multi-muscle synergies from EMG-EMG coherence is presented and these are compared with classically defined synergies. Coherent alpha-band (8-16 Hz) drive was strongest among muscles whose gross activity levels are well correlated within a given task. The cross-muscle distribution and temporal modulation of coherent alpha-band drive suggests a possible role in the neural coordination/monitoring of synergies.

ABSTRACT

During movement, groups of muscles may be controlled together by the nervous system as an adaptable functional entity, or 'synergy'. The rules governing when (or if) this occurs during voluntary behaviour in humans are not well understood, at least in part because synergies are usually defined by correlated patterns of muscle activity without regard for the underlying structure of their neural control. In this study, we investigated the extent to which comodulation of muscle output (i.e. correlation of electromyographic (EMG) amplitudes) implies that muscles share intermuscular neural input (assessed via EMG-EMG coherence analysis). We first examined this relationship among pairs of upper limb muscles engaged in an arm cycling task. We then applied a novel multidimensional EMG-EMG coherence analysis allowing synergies to be characterized on the basis of shared neural drive. We found that alpha-band coherence (8-16 Hz) is related to the degree to which overall muscle activity levels correlate over time. The extension of this coherence analysis to describe the cross-muscle distribution and temporal modulation of alpha-band drive revealed a close match to the temporal and structural features of traditionally defined muscle synergies. Interestingly, the coherence-derived neural drive was inversely associated with, and preceded, changes in EMG amplitudes by ∼200 ms. Our novel characterization of how alpha-band neural drive is dynamically distributed among muscles is a fundamental step forward in understanding the neural origins and correlates of muscle synergies.

Identifying bidirectional total and non-linear information flow in functional corticomuscular coupling during a dorsiflexion task: a pilot study

Background

The key challenge to constructing functional corticomuscular coupling (FCMC) is to accurately identify the direction and strength of the information flow between scalp electroencephalography (EEG) and surface electromyography (SEMG). Traditional TE and TDMI methods have difficulty in identifying the information interaction for short time series as they tend to rely on long and stable data, so we propose a time-delayed maximal information coefficient (TDMIC) method. With this method, we aim to investigate the directional specificity of bidirectional total and nonlinear information flow on FCMC, and to explore the neural mechanisms underlying motor dysfunction in stroke patients.

Methods

We introduced a time-delayed parameter in the maximal information coefficient to capture the direction of information interaction between two time series. We employed the linear and non-linear system model based on short data to verify the validity of our algorithm. We then used the TDMIC method to study the characteristics of total and nonlinear information flow in FCMC during a dorsiflexion task for healthy controls and stroke patients.

Results

The simulation results showed that the TDMIC method can better detect the direction of information interaction compared with TE and TDMI methods. For healthy controls, the beta band (14–30 Hz) had higher information flow in FCMC than the gamma band (31–45 Hz). Furthermore, the beta-band total and nonlinear information flow in the descending direction (EEG to EMG) was significantly higher than that in the ascending direction (EMG to EEG), whereas in the gamma band the ascending direction had significantly higher information flow than the descending direction. Additionally, we found that the strong bidirectional information flow mainly acted on Cz, C3, CP3, P3 and CPz. Compared to controls, both the beta-and gamma-band bidirectional total and nonlinear information flows of the stroke group were significantly weaker. There is no significant difference in the direction of beta- and gamma-band information flow in stroke group.

Conclusions

The proposed method could effectively identify the information interaction between short time series. According to our experiment, the beta band mainly passes downward motor control information while the gamma band features upward sensory feedback information delivery. Our observation demonstrate that the center and contralateral sensorimotor cortex play a major role in lower limb motor control. The study further demonstrates that brain damage caused by stroke disrupts the bidirectional information interaction between cortex and effector muscles in the sensorimotor system, leading to motor dysfunction.

Correlation Evaluation of Functional Corticomuscular Coupling With Abnormal Muscle Synergy After Stroke

OBJECTIVE

While neuroplasticity and functional reorganization during motor recovery can be indirectly reflected and evaluated by functional corticomuscular coupling (fCMC), little work has been published regarding the cortical origin of abnormal muscle synergy and compensatory mechanism in the separation movement of stroke patients.

METHODS

In this study, we proposed to use extended partial directed coherence (ePDC) combined with an optimal spatial filtering approach to estimate fCMC in stroke patients and healthy controls, and further established muscle synergy model (MSM) to jointly explore the modulation mechanism between cortex and muscles.

RESULTS

Compared to healthy controls, stroke patients had significantly reduced coupling strength in both descending and ascending pathway. Moreover, the MSM were abnormal with high variability and low similarity in the separation stage of stroke patients. Further exploration of the positive relationship between fCMC characteristics and MSM parameters proved the possibility of using fCMC-MSM-based correlation indicator to evaluate abnormality of the cortical related synergy movement as well as the rehabilitation level of stroke patients.

CONCLUSION

We developed a computational procedure to evaluate the correlation between fCMC and MSM in stroke patients.

SIGNIFICANCE

This article provides a quantitative evaluation metrics based on fCMC to reveal the deficits during poststroke motor restoration and a promising approach to help patients correct abnormal movement habits, paving the way for neurophysiological assessment of neuromuscular control in conjunction with clinical scores.

Cross-frequency and iso-frequency estimation of functional corticomuscular coupling after stroke

Functional corticomuscular coupling (FCMC) between the brain and muscles has been used for motor function assessment after stroke. Two types, iso-frequency coupling (IFC) and cross-frequency coupling (CFC), are existed in sensory-motor system for healthy people. However, in stroke, only a few studies focused on IFC between electroencephalogram (EEG) and electromyogram (EMG) signals, and no CFC studies have been found. Considering the intrinsic complexity and rhythmicity of the biological system, we first used the wavelet package transformation (WPT) to decompose the EEG and EMG signals into several subsignals with different frequency bands, and then applied transfer entropy (TE) to analyze the IFC and CFC relationship between each pair-wise subsignal. In this study, eight stroke patients and eight healthy people were enrolled. Results showed that both IFC and CFC still existed in stroke patients (EEG → EMG: 1:1, 3:2, 2:1; EMG → EEG: 1:1, 2:1, 2:3, 3:1). Compared with the stroke-unaffected side and healthy controls, the stroke-affected side yielded lower alpha, beta and gamma synchronization (IFC: beta; CFC: alpha, beta and gamma). Further analysis indicated that stroke patients yielded no significant difference of the FCMC between EEG → EMG and EMG → EEG directions. Our study indicated that alpha and beta bands were essential to concentrating and maintaining the motor capacities, and provided a new insight in understanding the propagation and function in the sensory-motor system.

Beta-Range Corticomuscular Coupling Reflects Asymmetries in Hand Movement

Hand movement in humans is verified as asymmetries and lateralization, and two hemispheres make some distinct but complementary contributions in the control of hand movement. However, little research has been done on whether the information transfer of the motor system is different between left and right hand movement. Considering the importance of functional corticomuscular coupling (FCMC) between the motor cortex and contralateral muscle in movement assessment, this study aimed to explore the differences between left and right hand by investigating the interaction between muscle and brain activity. Here, we applied the transfer spectral entropy (TSE) algorithm to quantize the connection between electroencephalogram (EEG) over the brain scalp and electromyogram (EMG) from extensor digitorum (ED) and flexor digitorum superficialis (FDS) muscles recorded simultaneously during a gripping task. Eight healthy subjects were enrolled in this study. Results showed that left hand yielded narrower and lower beta synchronization compared to the right. Further analysis indicated coupling strength in EEG-EMG(FDS) combination was higher at beta band than that in EEG-EMG(ED) combination, and exhibited distinct differences between descending (EEG to EMG direction) and ascending (EMG to EEG direction) direction. This study presents the distinctions of beta-range FCMC between left and right hand, and confirms the importance of beta synchronization in understanding the mechanism of motor stability control. The cortex-muscle FCMC might be used as an evaluation approach to explore the difference between left and right movement system.

Measurement of sensory deficiency in fine touch after stroke during textile fabric stimulation by electroencephalography (EEG)

Objective

Sensory deficiency of fine touch limits the restoration of motor functions after stroke, and its evaluation was seldom investigated from a neurological perspective. In this study, we investigated the cortical response measured by electroencephalography (EEG) on the fine touch sensory impairment during textile fabric stimulation after stroke.

Approach

Both participants with chronic stroke (n = 12, stroke group) and those unimpaired (n = 15, control group) were recruited. To investigate fine touch during textile fabric stimulations, full brain EEG recordings (64-channel) were used, as well as the touch sensation questionnaires based on the American Association of Textile Chemists and Colorists (AATCC) Evaluation Procedure 5. During the EEG measurement, relative spectral power (RSP) and EEG topography were used to evaluate the neural responses toward the fabric stimuli. In the subjective questionnaire, the fine touch for fabric stimuli was rated and represented by 13 different sensation parameters. The correlation between the fine touch evaluated by the EEG and the questionnaire was also investigated.

Main results

The neural responses of individuals with fine touch impairments after stroke were characterized by a shifted power spectrum to a higher frequency band, enlarged sensory cortical areas and higher RSP intensity (P < 0.05). Asymmetric neural responses were obtained when stimulating different upper limbs for both unimpaired participants and stroke participants (P < 0.05). The fine touch sensation of the stroke participants was impaired even in the unaffected limb. However, as a result of different neural processes, the correlation between the EEG and the questionnaire was weak (r < 0.2).

Significance

EEG RSP was able to capture the varied cortical responses induced by textile fabric fine touch stimulations related to the fine touch sensory impairment after stroke.

Rhythmic light flicker rescues hippocampal low gamma and protects ischemic neurons by enhancing presynaptic plasticity

The complex relationship between specific hippocampal oscillation frequency deficit and cognitive dysfunction in the ischemic brain is unclear. Here, using a mouse two-vessel occlusion (2VO) cerebral ischemia model, we show that visual stimulation with a 40 Hz light flicker drove hippocampal CA1 slow gamma and restored 2VO-induced reduction in CA1 slow gamma power and theta-low gamma phase-amplitude coupling, but not those of the high gamma. Low gamma frequency lights at 30 Hz, 40 Hz, and 50 Hz, but not 10 Hz, 80 Hz, and arrhythmic frequency light, were protective against degenerating CA1 neurons after 2VO, demonstrating the importance of slow gamma in cognitive functions after cerebral ischemia. Mechanistically, 40 Hz light flicker enhanced RGS12-regulated CA3-CA1 presynaptic N-type calcium channel-dependent short-term synaptic plasticity and associated postsynaptic long term potentiation (LTP) after 2VO. These results support a causal relationship between CA1 slow gamma and cognitive dysfunctions in the ischemic brain.

Altered Corticomuscular Coherence (CMCoh) Pattern in the Upper Limb During Finger Movements After Stroke

Background: Proximal compensation to the distal movements is commonly observed in the affected upper extremity (UE) of patients with chronic stroke. However, the cortical origin of this compensation has not been well-understood. In this study, corticomuscular coherence (CMCoh) and electromyography (EMG) analysis were adopted to investigate the corticomuscular coordinating pattern of proximal UE compensatory activities when conducting distal UE movements in chronic stroke.

Method: Fourteen chronic stroke subjects and 10 age-matched unimpaired controls conducted isometric finger extensions and flexions at 20 and 40% of maximal voluntary contractions. Electroencephalogram (EEG) data were recorded from the sensorimotor area and EMG signals were captured from extensor digitorum (ED), flexor digitorum (FD), triceps brachii (TRI), and biceps brachii (BIC) to investigate the CMCoh peak values in the Beta band. EMG parameters, i.e., the EMG activation level and co-contraction index (CI), were analyzed to evaluate the compensatory muscular patterns in the upper limb.

Result: The peak CMCoh with statistical significance (P < 0.05) was found shifted from the ipsilesional side to the contralesional side in the proximal UE muscles, while to the central regions in the distal UE muscle in chronic strokes. Significant differences (P < 0.05) were observed in both peak ED and FD CMCohs during finger extensions between the two groups. The unimpaired controls exhibited significant intragroup differences between 20 and 40% levels in extensions for peak ED and FD CMCohs (P < 0.05). The stroke subjects showed significant differences in peak TRI and BIC CMCohs (P < 0.01). No significant inter- or intra-group difference was observed in peak CMCoh during finger flexions. EMG parameters showed higher EMG activation levels in TRI and BIC muscles (P < 0.05), and higher CI values in the muscle pairs involving TRI and BIC during all the extension and flexion tasks in the stroke group than those in the control group (P < 0.05).

Conclusion: The post-stroke proximal muscular compensations from the elbow to the finger movements were cortically originated, with the center mainly located in the contralesional hemisphere.

Musical Sonification of Arm Movements in Stroke Rehabilitation Yields Limited Benefits

Neurologic music therapy in rehabilitation of stroke patients has been shown to be a promising supplement to the often strenuous conventional rehabilitation strategies. The aim of this study was threefold: (i) replicate results from a previous study with a sample from one clinic (henceforth called Site 1; N = 12) using an already established recording system, and (ii) conceptually replicate previous findings with a less costly hand-tracking system in Site 2 (N = 30), and (iii) compare both sub-studies’ outcomes to estimate the efficiency of neurologic music therapy. Stroke patients in both sites were randomly assigned to treatment or control groups and received daily training of guided sequential upper limb movements additional to their standard stroke rehabilitation protocol. Treatment groups received sonification (i.e., changes in musical pitch) of their movements when they moved their affected hand up and down to reproduce a sequence of the first six notes of a C major scale. Controls received the same movement protocol, however, without auditory feedback. Sensors at the upper arm and the forearm (Xsens) or an optic sensor device (Leapmotion) allowed to measure kinematics of movements and movement smoothness. Behavioral measures pre and post intervention included the Fugl-Meyer assessment (FMA) and the Stroke Impact Scale (SIS) and movement data. Bayesian regression did not show evidence supporting an additional effect of sonification on clinical mobility assessments. However, combined movement data from both sites showed slight improvements in movement smoothness for the treatment group, and an advantage for one of the two motion capturing systems. Exploratory analyses of EEG-EMG phase coherence during movement of the paretic arm in a subset of patients suggested increases in cortico-muscular phase coherence specifically in the ipsilesional hemisphere after sonification therapy, but not after standard rehabilitation therapy. Our findings show that musical sonification is a viable treatment supplement to current neurorehabilitation methods, with limited clinical benefits. However, given patients’ enthusiasm during training and the low hardware price of one of the systems it may be considered as an add-on home-based neurorehabilitation therapy.

Direct Interaction on Specific Frequency Bands in Functional Corticomuscular Coupling

OBJECTIVE

Direct interaction between the brain and muscle is significant for investigating the oscillation mechanisms in the motor control system.

METHODS

To our knowledge, the partial directed coherence (PDC) method is sufficient to reflect the direct interaction among multivariate time series in the frequency domain, but fails to eliminate the spectral overlap among frequency bands. Therefore, we expanded the PDC method and constructed a novel method, named variational-mode-decomposition-based PDC (VMDPDC), to describe the direct interaction on specific frequency bands.

RESULTS

To verify this, we made a comparison with the Granger causality (GC), PDC, and FIR-based PDC (FIRPDC) methods in two numerical models (bivariate coupling model and multivariate coupling model). After that, we applied this method to analyze the functional corticomuscular coupling (FCMC) during steady-state grip task. Simulation results showed that, compared with the GC, PDC, and FIRPDC methods, the VMDPDC method could accurately detect the direct interaction on specific frequency bands. The results on experimental data showed that the direct interaction in FCMC mainly focused on the alpha (8-15 Hz), beta (15-35 Hz), and gamma (35-60 Hz) bands. Further analysis demonstrated that the coupling strength in descending direction was significantly higher than that in the opposite direction.

CONCLUSION

Both simulation and experimental results indicated that the proposed method could effectively describe the direct interaction on specific frequency bands.

SIGNIFICANCE

This study also provides a theoretical foundation for further exploration on the mechanism of the motor control.